Prevalence of Periodontal Disease among Patients Reporting to Tertiary Care Hospital in Ranchi.

Background: Despite a huge number of advancements in the medical field, periodontitis still remains one of the most prevalent oral diseases worldwide. Aim: Thus, the primary aim of our study was to evaluate the prevalence of periodontal diseases in patients reporting to the tertiary healthcare setup in Ranchi. Materials and Methods: Based on inclusion criteria, subjects aged 18-60 years were selected and a per forma was filled by the observer. The prevalence of periodontal disease was measured using the community periodontal index, simplified oral hygiene index, and stage of periodontitis. Results: Descriptive variables were assessed using frequency, percentage, mean, and standard deviations, while the categorical analysis was performed using the Chi-square tests. Conclusion: General awareness about periodontal health and regular dental visits should be given utmost importance among the rural populations of every developing country.

Prevalence of poor sleep quality among physicians and nurses in a tertiary health care center.

Objectives: Sleep quality among tertiary healthcare professionals in KSA has not been well studied. Therefore, in this study, we aimed to assess sleep quality among physicians and nurses in a tertiary care center in Jeddah City and to identify the associated factors. Methods: In this quantitative, analytical, cross-sectional study, an online, self-administered questionnaire was distributed to all physicians and nurses working at King Abdulaziz University Hospital (KAUH). A total of 395 healthcare professionals participated in this study. The questionnaire included the participants' demographic characteristics and Pittsburgh Sleep Quality Index (PSQI) values. Results: The mean age and body mass index of the participating healthcare professionals were 37.74 ± 10.35 years and 26.32 ± 4.97 kg/m2, respectively. Most participants were women (70.4%) and expatriates (55.4%). The prevalence of poor sleep quality was high: 70.4% of the participants had a PSQI score >5. Several factors, such as female sex (adjusted odds ratio (AOR) = 2.03; 95% confidence interval (CI) = 1.11-3.74), shift work (AOR = 1.87; 95% CI = 1.01-3.45), physical inactivity (AOR = 2.43; 95% CI = 1.01-5.85), and current smoking (AOR = 4.64; 95% CI = 1.68-12.80), were associated with poor sleep quality among healthcare professionals. Conclusions: Our findings are consistent with those from previous studies indicating high prevalence of poor sleep quality among healthcare professionals. Furthermore, female sex, shift work, smoking, and physical inactivity were identified as risk factors for poor sleep quality.

Clinico-Demographic Profile Of Soft Tissue Sarcoma- 5 Year Experience From A Tertiary Care Centre Of Eastern India.

Soft tissue sarcomas (STS) are a diverse group of malignant mesenchymal neoplasm.But, due to their low prevalence, very little data is available worldwide as well as in India regarding their clinico-epidemiological pattern.In this study we analysed the clinico-demographic profile of STS patients attending a tertiary care centre of Eastern India over the last 5 years. We analyzed the prospectively maintained database of a tertiary care centre of West Bengal in Eastern India, and collected the data regarding the demography, clinical profile, pathology and treatment of STS patients who attended our OPD between 2017-2021. The objective was to assess the demographic and clinical data of STS patients of Eastern India and compare it with those of the reported literature from rest of the country as well as outside world. Most of the cases (27%) were between 41-50 years of age group with a slight male predominance (Male: Female = 1.01:1). Spindle cell sarcoma was the most common (24.3%) histology followed by undifferentiated pleomorphic sarcoma (15%) and extremities were the most common site of involvement (47.7%). 71% patients presented with stage III and advanced disease.81% patients underwent radical surgery,14% patient received neo-adjuvant and 60% received adjuvant radiotherapy.91% patients received systemic chemotherapy. To conclude, this study is one of its first from Eastern India and will act as a stepping stone for future studies concentrating on clinico-epidemiological profile, early diagnosis and treatment of STS.

Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis.

Background: Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective: To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods: Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0-18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results: Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review: 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews: studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children's workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions: Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration: This study is registered as PROSPERO CRD42019159008. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.

Between 5% and 30% of children experience constipation at some stage. In one-third of these children, this progresses to chronic functional constipation. Chronic functional constipation affects more children with additional needs. We aimed to find and bring together published information about treatments for chronic functional constipation, to help establish best treatments and treatment combinations. We did not cover assessment or diagnosis of chronic functional constipation. This project was guided by a 'stakeholder group', including parents of children with constipation, people who experienced constipation as children, and healthcare professionals/continence experts. We carried out a 'scoping review' and a series of 'systematic reviews'. Our 'scoping review' provides an overall picture of research about treatments, with 651 studies describing 48 treatments. This helps identify important evidence gaps. 'Systematic reviews' are robust methods of bringing together and interpreting research evidence. Our stakeholder group decided to structure our systematic reviews to reflect who delivered the interventions. We brought together evidence about how well treatments worked when delivered by families/carers (32 studies), the wider children's workforce (e.g. general practitioner, health visitor) (21 studies), continence teams (31 studies) or specialist consultant-led teams (42 studies). We also considered complementary therapies (15 studies) and behavioural strategies (4 studies). Care is affected by what is done and how it is done. We brought together evidence about different models of delivering care (15 studies), barriers and facilitators to implementation of treatments (106 studies) and costs (31 studies). Quality of evidence was mainly low to very low. Despite numerous studies, there was often insufficient information to support generalisable conclusions. Our findings generally agreed with current clinical guidelines. Management of childhood chronic functional constipation should be child-centred, multifaceted and adapted according to the individual child, their needs, the situation in which they live and the health-care setting in which they are looked after. Research is needed to address our identified evidence gaps.

Clinico-Pathological Profile of Basaloid Skin Tumors-Experience from a Tertiary Care Center of Eastern India.

Basaloid tumors comprise a wide spectrum of benign and malignant tumors like basal cell carcinoma, seborrheic keratosis, pilomatricoma, basosquamous carcinoma, trichoblastoma, and cylindroma. Among them, basal cell carcinoma is the most common type which constitutes about 90% of all malignant skin tumor. This study was aimed at analyzing the clinico-pathological profile of basaloid skin tumors attending radiotherapy and surgery OPD of our institution and compares them with those of the reported literature from rest of the country as well as outside world. All cases of basaloid skin tumors presented at radiotherapy, surgery, and dermatology OPD between January 2020 and June 2021 with or without a histological diagnosis were evaluated. Those without a histological diagnosis underwent biopsy and categorized according to standard histological criteria. After histological confirmation, we collected demographic, clinical, and pathological data of the cases. Among 106 patients analyzed, 54.7% (58) cases were diagnosed as basal cell carcinoma followed by seborrheic keratosis (17.9%), pilomatricoma (13.2%), basosquamous carcinoma (9.4%), trichoblastoma (2.8%), and cylindroma (1.8%). Mean age of presentation was 57.03 (± 7.435) years, and head-neck region was the most common site of involvement for basal cell carcinoma. Twenty-two cases required immunohistochemical assessment for confirmation of diagnosis. To conclude, this study is one of its first from Eastern India and will act as a stepping stone for future studies concentrating on clinico-pathological profile, early diagnosis and treatment of basaloid skin tumors.

Odontologia hospitalar: uma análise crítica sobre a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil / Hospital dentistry: a critical analysis of the role of the dental surgeon in tertiary care in the state of Rio Grande do Sul, Brazil

Objetivo: analisar a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil. Método: estudo descritivo ecológico, com uso de dados secundários registrados pelo Cadastro Nacional de Estabelecimentos de Saúde no ano de 2023. A coleta de dados foi realizada em duas etapas. Na primeira etapa também foram coletados os dados do CNES referentes à presença do cirurgião dentista, tipo de vínculo contratual e especialidades ofertadas pelos serviços. Já na segunda etapa os dados coletados foram referentes aos indicadores sociodemográficos dos profissionais com habilitação em odontologia hospitalar utilizando as informações disponibilizadas pelo Sistema WSCFO do Conselho Federal de Odontologia. A análise dos dados foi realizada com o suporte do software TabWin, versão 3.6, e do software estatístico R v. 4.2.3. Os dados foram analisados por meio de análise descritiva. Resultados: apenas 6,11% das instituições são certificadas e consideradas Hospitais de Ensino. A maioria dos estabelecimentos (87,14%) oferece atendimento pelo SUS. Quanto à presença de cirurgiões dentistas nos estabelecimentos, 64,63% dos estabelecimentos relataram tê-los, enquanto 35,37% não possuem esse profissional em sua equipe. Neste estudo, constatamos que uma correlação positiva do cirurgião dentista com o número de leitos de UTI adulto e ao maior porte do hospital. Conclusão: observa-se que ainda há necessidade de estruturação da atenção terciária no Estado do Rio Grande do Sul, no que se refere à odontologia hospitalar. Há poucos os cirurgiões dentistas com uma carga horária dedicada exclusivamente ao atendimento hospitalar clínico a beira leito.(AU)

Objective: To analyze the inclusion of dental surgeons in tertiary care in the state of Rio Grande do Sul, Brazil. Method: a descriptive ecological study using secondary data recorded by the National Register of Health Establishments in 2023. Data was collected in two stages. In the first stage, data was also collected from the CNES regarding the presence of a dental surgeon, the type of contractual relationship and the specialties offered by the services. In the second stage, data was collected on the sociodemographic indicators of professionals qualified in hospital dentistry using the information provided by the WSCFO System of the Federal Council of Dentistry. The data was analyzed using TabWin software, version 3.6, and R v. 4.2.3 statistical software. The data was analyzed using descriptive analysis. Results: only 6.11% of institutions are certified and considered Teaching Hospitals. The majority of establishments (87.14%) provide care through the SUS. As for the presence of dental surgeons in the establishments, 64.63% of the establishments reported having them, while 35.37% did not have this professional on their team. In this study, we found a positive correlation between the number of adult ICU beds and the size of the hospital. Conclusion: There is still a need to structure tertiary care in the state of Rio Grande do Sul, in terms of hospital dentistry. There are few dental surgeons with a workload dedicated exclusively to bedside clinical hospital care.(AU)

Quality management in the COVID-19 pandemic: nursing action plan / Gestión de la calidad en la pandemia de COVID-19: plan de acción de enfermería / Gestão da qualidade na pandemia de COVID-19: plano de ação da enfermagem

ABSTRACT Objectives: to describe the implementation of a nursing action plan to face the pandemic of COVID 19 in a University Hospital in the state of Rio de Janeiro. Methods: this is an experience report, in which two management tools were used: the Ishikawa Diagram to identify problems and the 5W2H spreadsheet to outline the actions according to the situations presented. Results: four categories were listed in two groups: 1- Actions of the Nurse Manager in the Organization of Logistics, Infrastructure and Care: materials and environment; and 2- Nursing Human Resources Management and Continuing Education: method and human resources. Final Considerations: the plan developed showed the role of nursing management, with the search for best care practices, development of protocols, carrying out multi-professional training and management of supplies.

RESUMEN Objetivos: describir la implementación de un plan de acción de enfermería para enfrentamiento de la pandemia de COVID-19 en un hospital universitario del estado de Rio de Janeiro. Métodos: tratase de un relato de experiencia, en lo cual fueron utilizadas dos herramientas de gestión: el Diagrama de Ishikawa, para el levantamiento de los problemas; y la hoja de cálculo 5W2H, para seguir las acciones de acuerdo con las situaciones presentadas. Resultados: fueron enumeradas cuatro categorías en dos grupos: 1) Actuación del enfermero gestor en la organización de logística, infraestructura y asistencia: materiales y medio ambiente; y 2) Gestión de los recursos humanos de enfermería y educación permanente: método y recursos humanos. Consideraciones Finales: el plan elaborado evidenció el protagonismo de la gestión de enfermería, con búsqueda por las mejores prácticas asistenciales, elaboración de protocolos, realización de entrenamientos multiprofesionales y gestión de insumos.

RESUMO Objetivos: descrever a implementação de um plano de ação da enfermagem para enfrentamento da pandemia de COVID-19 em um hospital universitário do estado do Rio de Janeiro. Métodos: trata se de um relato de experiência, no qual foram utilizadas duas ferramentas de gestão: o Diagrama de Ishikawa, para o levantamento dos problemas; e a planilha 5W2H, para traçar as ações de acordo com as situações apresentadas. Resultados: foram elencadas quatro categorias em dois grupos: 1) Atuação do enfermeiro gestor na organização de logística, infraestrutura e assistência: materiais e meio ambiente; e 2) Gerenciamento dos recursos humanos de enfermagem e educação permanente: método e recursos humanos. Considerações Finais: o plano elaborado evidenciou o protagonismo da gestão de enfermagem, com busca pelas melhores práticas assistenciais, elaboração de protocolos, realização de treinamentos multiprofissionais e gestão de insumos.

Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study.

BACKGROUND: Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. OBJECTIVE: This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. METHODS: A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ≥1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. RESULTS: A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. CONCLUSIONS: We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.8367.

Agressão verbal contra profissionais de saúde da atenção primária e terciária: estudo de métodos mistos / Verbal aggression against health professionals in primary and tertiary care: a mixed methods study / Agresión verbal contra profesionales de la salud en atención primaria y terciaria: un estudio de métodos mixtos

Objetivo: analisar a ocorrência da agressão verbal e fatores associados ao fenômeno contra trabalhadores de saúde. Método: estudo misto, explanatório sequencial, desenvolvido de 2016 a 2019, com 647 trabalhadores de serviços de saúde das regiões Oeste e Extremo Oeste de Santa Catarina. Utilizaram-se o Survey Questionnaire Workplace Violence in the Health Sector e entrevistas semiestruturadas. Realizaram-se as análises estatística inferencial e temática, respectivamente. Resultados: dos participantes, 307 (47,4%) relataram terem sofrido ao menos um episódio de agressão verbal. Esse evento foi associado à função do trabalhador, ao contato físico com paciente, ao reconhecimento no trabalho e à preocupação com a violência no trabalho. Os depoimentos apontam os impactos na saúde dos trabalhadores e a fragilidade das condutas após os episódios. Conclusão: a agressão verbal é uma violência típica dos serviços públicos de saúde, com vítimas que possuem um perfil comum e instituições com dificuldade de manejo deste problema.

Objective: to analyze the occurrence of verbal aggression and factors associated with the phenomenon against health workers. Method: mixed study, sequential explanatory, developed from 2016 to 2019, with 647 health service workers from the West and Far West regions of Santa Catarina. The Survey Questionnaire Workplace Violence in the Health Sector and semi-structured interviews were used. Inferential and thematic statistical analyzes were carried out, respectively. Results: of the participants, 307 (47.4%) reported having suffered at least one episode of verbal aggression. This event was associated with the role of the worker, physical contact with the patient, recognition at work, and concern about violence at work. The testimonies point out the impacts on the health of workers and the fragility of the conducts after the episodes. Conclusion: verbal aggression is a typical violence of public health services, with victims who have a common profile and institutions with difficulty in managing this problem.

Objetivo: analizar la ocurrencia de agresiones verbales y factores asociados al fenómeno contra trabajadores de la salud. Método: estudio explicativo mixto, secuencial, desarrollado entre 2016 y 2019, con 647 trabajadores de los servicios de salud de las regiones Oeste y Lejano Oeste de Santa Catarina. Se utilizó el Survey Questionnaire Workplace Violence in the Health Sector y entrevistas semiestructuradas. Se realizaron análisis estadísticos inferenciales y temáticos, respectivamente. Resultados: de los participantes, 307 (47,4%) relataron haber al menos un episodio de agresión verbal. Este evento se asoció con el rol del trabajador, el contacto físico con el paciente, el reconocimiento en el trabajo y la preocupación por la violencia en el trabajo. Los testimonios apuntan los impactos en la salud de los trabajadores y la fragilidad de los comportamientos tras los episodios. Conclusión: la agresión verbal es una violencia típica de los servicios públicos de salud, con víctimas que tienen un perfil común e instituciones con dificultad en el manejo de este problema.

Evaluating the implementation of the standard treatment guidelines (STGs) and essential medicines list (EML) at a public South African tertiary institution and its associated primary health care (PHC) facilities.

BACKGROUND: The standard treatment guidelines (STGs) and essential medicines list (EML) were a policy option recommended in the National Drug Policy for South Africa in 1996 to address the irrational and bloated medicines procurement list. STGs/EML serve as a tool to promote cost-effective use of medicines; rational prescribing; and improve accessibility to medicines for all citizens. The purpose of this study was to evaluate the use and implementation of the STGs/EML by prescribers at a public tertiary institution and its associated Primary Health Care (PHC) facilities in the uMhlathuze subdistrict of KwaZulu Natal. The study aimed to provide feedback and to make recommendations to policy makers to improve the use and implementation of the STGs/EML and to inform National Health Insurance (NHI) policy development. METHOD: An observational quantitative descriptive research design was used. A retrospective audit of prescriptions was conducted, and questionnaires were utilized to collect data from prescribers and the facilities to evaluate the utilization of the STGs/EML and the rational use of medicines. All descriptive analyses were presented as counts with percentages, and Fisher's exact test was used to compare results. The data was summarized, reduced, and analysed using SAS statistics software. RESULTS: 107 medical doctors (97%) responded to the questionnaire at hospital level and 98 nurses (98%) responded to the questionnaire at the PHC level. Results revealed that the majority of doctors, 94.4%, had access to the latest STGs/EML compared with only 41.8% of nurses. 70.3% and 78.3% of doctor's and nurse's prescriptions, respectively, adhered to the guidelines. 94.9% of nurses requested training on the use of STGs/EML as most of them had not received formal training on its use. CONCLUSION: This study showed suboptimal adherence to STGs/EML by all prescribers, in contrast to previous research amongst nurses when hardcopies were available. Training on the use of the STGs/EML is needed at PHC level and improved monitoring of STGs/EML compliance is necessary. This study may be replicated for a wider population to paint a national picture and to periodically assess the extent of the implementation of the STGs/EML.

Knowledge, attitudes and practices of health care providers trained in responding to violence against women: a pre- and post-intervention study.

BACKGROUND: Violence against women is a serious public health concern, and is highly prevalent globally, including in India. Health-care providers [HCPs] can play an important role in addressing and reducing negative consequences of violence against women. We implemented a pre-post intervention study of HCP training in three tertiary care facilities in Maharashtra, India. METHODS: The study used a pre-post intervention design with assessment of HCPs' (n = 201) knowledge, attitudes, perceived preparedness and practice at three time points: before training, after training and at 6 months follow- up. RESULTS: Total median score of knowledge about common signs and symptoms of violence (8.89 vs, 10.00), attitudes towards acceptability of violence (9.05 vs. 10.00), individual (6.74 vs. 10.00) and system level preparedness (6.11 vs. 8.14) improved from pre to post- training. The generalized estimating equation [GEE] model, adjusted for age, sex, site and department, showed an improvement in knowledge, attitudes and preparedness post- training. The change from pre to 6 months follow- up was not significant for attitude. CONCLUSIONS: This package of interventions, including training of HCPs, improved HCPs' knowledge, attitudes and practices, yet changes in attitudes and preparedness did not sustain over time. This study indicates feasibility and positive influence of a multi-component intervention to improve HCP readiness to respond to violence against women in a low-resource setting. Future phases of intervention development include adapting this intervention package for primary and secondary health facilities in this context, and future research should assess these interventions using a rigorous experimental design. Finally, these results can be used to advocate for multi-layered, systems-based approaches to strengthening health response to violence against women.

Panorama da vulnerabilidade dos pacientes oncológicos nas demandas por tratamentos de alto custo: o Sistema Único de Saúde à luz da Bioética / Overview of the vulnerability of cancer patients in demands for high-cost treatments: the Unified Health System in the light of Bioethics / Panoramade la vulnerabilidad de los pacientes con cáncer em las demandas de tratamientos de alto costo: el Sistema Único de Salud a la luzde la Bioética

Objetivo: avaliar a vulnerabilidade dos pacientes oncológicos no acesso a tratamentos de alto custo no contexto do Sistema Único de Saúde (SUS). Metodologia: o presente artigo possui abordagem qualitativa, a partir de pesquisa bibliográfica notadamente de artigos publicados em periódicos especializados nas áreas da Bioética e Saúde, bem como a análise das teses fixadas pelo Supremo Tribunal Federal (STF) sobre o fornecimento de tratamentos de alto custo pelos entes federativos. Trata-se, quanto ao objetivo, de pesquisa descritiva, caracterizando, ao final, a vulnerabilidade dos pacientes oncológicos, não obstante a previsão normativa de direitos que lhe são assegurados. Resultados: o SUS viabiliza aos cidadãos o acesso igualitário, universal e gratuito às ações e serviços de saúde, todavia, pacientes que necessitam de assistência de alta complexidade, em nível de atenção terciária à saúde, ficam vulneráveis diante das iniquidades do acesso à saúde pública, sobretudo em virtude da tecnologia de alto custo a que podem estar associados os tratamentos. Conclusões: segundo a literatura médica, dentre outros direitos à pessoa com câncer, previstos em legislações esparsas, está a oferta de tratamento adequado, de forma oportuna e segura. Ocorre que a burocratização e as falhas na prestação do serviço de saúde pública fazem com que os pacientes acometidos com neoplasias enfrentem entraves para a fruição do direito à saúde e, como consequência, formulem demandas judiciais visando à concessão judicial de tratamentos de alto custo.

Objective: this work aims todiscuss about the vulnerability of cancer patients in accessing high-cost treatments in the Unified Health System (SUS, in Portuguese). Methods: the approach was qualitative, based on bibliographic researchofarticles published in bioethics and health journals, as well as analysis of the theses established by the Supreme Federal Court about the provision of high-cost treatments by Brazilian states. It is also, regarding the objective of de descriptive research, characterizing, in the end, the vulnerability of cancer patients, despite the normative prediction of rights that are guaranteed to them. Results: SUS enables citizens to have equal, universal, and free access to health services, however, patients who need assistance health care of high complexity are vulnerable in the face of inequities in access to public health, dueto the high-cost technology that these treatments can be associated with. Conclusion: the patientwith cancer should be given appropriate treatment in a timely and safe manner, according to the medical literature. However, bureaucracyand failure to provide public health services cause patients affected with neoplasms to face barriers to fulfilltheir right to health.Thus, they seekforjudicial demand aiming at the judicial concession of high-cost treatments.

Objetivo: evaluar la vulnerabilidad de los pacientes oncológicos en el acceso a tratamientos de alto costo en el contexto del Sistema Único de Salud (SUS). Metodología: este artículo tiene un enfoque cualitativo, basado en la investigación bibliográfica notificada de artículos publicados en revistas especializadas en las áreas de Bioética y Salud, así como el análisis de tesis fijadas por el Supremo Tribunal Federal sobre la provisión de tratamientos de alto costo por parte de entidades federativas. Se trata de una investigación descriptiva, que caracteriza, al final, la vulnerabilidad de los pacientes con cáncer, a pesar de la predicción normativa de los derechos que se les garantizan. Resultados: el SUS permite a los ciudadanos el acceso igualitario, universal y gratuito a las acciones y servicios de salud, sin embargo, los pacientes que requieren atención de alta complejidad, a nivel de atención terciaria de salud, son vulnerables a las inequidades de acceso a la salud pública, especialmente debido a la tecnología de alto costo a la que se pueden asociar los tratamientos. Conclusión: según la literatura médica, entre otros derechos a la persona con cáncer, previstos en escasa legislación, se encuentra la prestación de un tratamiento adecuado, de manera oportuna y segura. Parece que la burocratización y las fallas en la prestación de los servicios públicos de salud hacen que los pacientes afectados con neoplasias se enfrenten a obstáculos para el disfrute del derecho a la salud y, como consecuencia, hagan demandas legales dirigidas a la concesión judicial de tratamientos de alto costo.

Interdisciplinarity and interprofessionality in teamwork: perceptions of multiprofessional residents in Hospital Care

Multiprofessional Health Residency Programs were created to further align health training with the needs of the population and, through an emphasis on teamwork, have been contributing to the consolidation of the Brazilian Unified Health System. The present study sought to understand the perceptions of a group of multiprofessional residents in Hospital Care about interdisciplinarity and interprofessionality within the scope of teamwork. This is a qualitative study that had the participation of 29 multiprofessional residents in the 'Hospital Care' area of concentration, all female (six psychologists, six social workers, six nurses, six physiotherapists and five nutritionists). Data were collected by means of a semi-structured interview script. The corpuswas subjected to thematic content analysis. Most of the participants: (1) reported that their first contact with the notion of interdisciplinarity occurred when they were in college, which led to them assimilating it as a synonym for joint action, and (2) claimed to have no knowledge of the notion of interprofessionality, but valued the horizontalization of relations between health professionals. Additionally, important conditions concerning both interdisciplinarity and interprofessionality were not emphasized by the participants. Further studies on the subject are needed, due to its importance for public health.

Fatores intervenientes na qualidade de vida de trabalhadores de enfermagem em jornada noturna / Intervening factors in the quality of life of nursing workers on a night shift / Factores que intervienen en la calidad de vida de los trabajadores de enfermería en turno de noche

Objetivo: analisar os fatores intervenientes na qualidade de vida de trabalhadores de enfermagem em jornada noturna. Método: estudo analítico, transversal, quantitativo, realizado com 105 profissionais de enfermagem de um hospital com jornada noturna. Utilizaram-se questionários para avaliação socioeconômica e demográfica e da qualidade de vida. Os dados foram discutidos por meio de análise bivariada e análise comparativa, com nível de significância de 5% (p≤0,05). Resultados: verificou-se associação estatisticamente significante entre a qualidade de vida geral e as variáveis: renda familiar de até quatro salários mínimos (p=0,02), inatividade física (p=0,01), tempo de trabalho na instituição (p=0,02) e de atuação no período noturno (p=0,01) superiores a 11 anos. Os domínios psicológico, físico e meio ambiente interferiram negativamente na qualidade de vida dos sujeitos, apesar destes terem classificado-a como boa. Conclusão: portanto, os serviços de saúde devem adotar medidas para proteger a saúde de seus trabalhadores da influência de fatores profissionais.(AU)

Objective: to analyze the intervening factors in the quality of life of nursing workers working at night. Method: analytical, cross-sectional, quantitative study carried out with 105 nursing professionals from a hospital with a night shift. Questionnaires were used for socioeconomic and demographic and quality of life assessments. The data were discussed using bivariate analysis and comparative analysis, with a significance level of 5% (p≤0.05). Results: there was a statistically significant association between the general quality of life and the variables: family income of up to four minimum wages (p=0.02), physical inactivity (p=0.01), working time at the institution (p=0.02) and working at night (p=0.01) over 11 years. The psychological, physical and environmental domains negatively interfered with the subjects' quality of life, despite the fact that they classified it as good. Conclusion: therefore, health services must adopt measures to protect the health of their workers from the influence of professional factors.(AU)

Objetivo: analizar los factores que intervienen en la calidad de vida de trabajadores de enfermería que laboran de noche. Método: estudio analítico, transversal y cuantitativo realizado con 105 profesionales de enfermería nocturnos de un hospital. Se utilizaron cuestionarios para evaluaciones socioeconómicas, demográficas y de calidad de vida. Los datos se discutieron mediante análisis bivariada y análisis comparativo, con un nivel de significancia del 5% (p≤0.05). Resultados: hubo asociación estadísticamente significativa entre la calidad de vida general y las variables: ingreso familiar de hasta cuatro salarios mínimos (p=0,02), inactividad física (p=0.01), tiempo de trabajo en la institución (p=0,02) y trabajo nocturno (p=0,01) durante 11 años. Los dominios psicológico, físico y ambiental interfirieron negativamente en la calidad de vida de los sujetos, a pesar de clasificársela como buena. Conclusión: por tanto, los servicios de salud deben adoptar medidas para proteger la salud de sus trabajadores de la influencia de factores profesionales.(AU)

Múltiplos sentidos após a estomização: implicações para o início da socialização de pessoas com câncer colorretal / Significados múltiples después de la estomización: implicancias para el inicio de la socialización de personas con cáncer colorrectal / Multiple meanings after stomization: implications for the beginning of socialization of people with colorectal cancer

RESUMO Objetivo: compreender os sentidos atribuídos por pessoas com câncer colorretal e seus acompanhantes acerca do tratamento cirúrgico com estomização. Método: estudo etnográfico ancorado na sociologia compreensiva e pequenas narrativas. Realizado em clínica cirúrgica e ambulatório de um Centro de Alta Complexidade em Oncologia, Pará, Brasil, com 22 participantes. A coleta ocorreu entre julho de 2018 e fevereiro de 2019, por observação e registro em diário de campo e entrevistas semiestruturadas, com posterior análise de conteúdo indutiva. Resultados: apreenderam-se: Visualização da bolsa e o novo modo de encararem suas vidas; Sentidos angustiantes; Aprendizado no pós-operatório, a família e o apoio instrumental; Mudanças em atividades laborais, prazerosas e ameaça ao lazer e vaidade; Personificação do "corpo estranho" e indícios de interiorização. Conclusão: a socialização secundária foi explicada pelos círculos concêntricos de socialização. A enfermagem precisa atuar compartilhando conhecimentos técnico-procedimental-informacionais, informando para os adoecidos e acompanhantes as responsabilidades da esfera macrossocial.

RESUMEN Objetivo: comprender los significados atribuidos por personas con cáncer colorrectal y por quienes los acompañan acerca del tratamiento quirúrgico con estomización. Método: estudio etnográfico basado en la sociología comprensiva y narrativas breves. Se realizó con 22 participantes en el área de clínica quirúrgica y en el servicio ambulatorio de un Centro de Alta Complejidad en Oncología de Pará, Brasil. Los datos se recolectaron entre julio de 2018 y febrero de 2019, por medio de observaciones y registro en un diario de campo y entrevistas semiestructuradas, con posterior análisis inductivo de contenido. Resultados: se obtuvo lo siguiente: Visualización de la bolsa y el nuevo modo de encarar sus vidas; Significados angustiantes; Aprendizaje en el período post-operatorio, la familia y el apoyo instrumental; Cambios en actividades laborales, de placer o la amenaza al tiempo libre y la vanidad; Personificación del "cuerpo extraño" e indicios de internalización. Conclusión: la socialización secundaria se explicó por medio de sus círculos concéntricos. El área de Enfermería debe actuar compartiendo conocimientos técnicos-procedimentales-informativos, informando a los pacientes y a quienes los acompañan cuáles son las responsabilidades de la esfera macro-social.

ABSTRACT Objective: to understand the meanings attributed by people with colorectal cancer and by their companions to the surgical treatment with stomization. Method: an ethnographic study based on comprehensive sociology and short narratives. It was conducted with 22 participants in a surgical and outpatient clinic of an Oncology High-Complexity Center in Pará, Brazil. Collection was carried out between July 2018 and February 2019, by means of observation and recording in a field diary and semi-structured interviews, with subsequent inductive content analysis. Results: the following was apprehended: Visualization of the bag and the new way of facing their lives; Anguishing feelings; Learning in the post-operative period, the family and instrumental support; Changes in work activities, pleasure activities and threat to leisure and vanity; Personification of the "foreign body" and signs of internalization. Conclusion: secondary socialization was explained by the concentric circles of socialization. Nursing needs to act by sharing technical-procedural-informational knowledge, informing the sick and those accompanying them of the responsibilities of the macrosocial sphere.

Prevalence of Postpartum Depression in a Tertiary Health Care.

INTRODUCTION: Postpartum Depression is an important public health problem in developing country like Nepal.Although prevalence of postpartum depression is high in our setting, it is most neglected area of mental health. These have negative consequences not only to mother but also to infant. Data related to postpartum depression in Nepal are limited, research in this particular field will contribute in knowing the gravity of the situation and helps to formulate the factor association to upcoming researchers. This research is done in order to find out the prevalence of postpartum depression. METHODS: A descriptive cross-sectional study was carried out in Paropakar Maternity and Women's Hospital, among total 348 postnatal mothers who were selected through convenient sampling technique. Validated Nepalese version of Edinburg Postnatal Depression Scale was used to screen depressive symptoms. Data was collected after receiving ethical approval letter. Data entry was done using SPSS version 20. RESULTS: Out of total mothers, the prevalence of Postpartum Depression (PPD) was seen among 51 (14.7%) mothers. CONCLUSIONS: Postpartum Depression being a common yet neglected area of maternal health in Nepal, should be detected in early stage. As the study showed that about one sixth of mothers had postpartum depression, more focus should be given to maternal mental health.

Mortality from gastroschisis in the state of Rio de Janeiro: a 10-year series / Mortalidade por gastrosquise no estado do Rio de Janeiro: uma série de 10 anos

ABSTRACT OBJECTIVE To analyze mortality and associated factors in a series of gastroschisis at birth in the state of Rio de Janeiro in a 10-year period (2005 to 2014). METHOD A retrospective cohort study, which related the databases of the Live Births Information System and the Mortality Information System by probabilistic linkage. Final database was constructed in two stages: preparation of the two initial databases and establishment of relationships between them. RESULTS Preterm newborns and those with low birthweight had higher risk of death, with statistical significance (p = 0.03 and p = 0.006, respectively). Regarding place of birth, although death frequency was higher in maternity units than in general hospitals (p = 0.04; OR = 0.5; 95%CI 0.3-1.0), it was observed that a unit characterized as a general hospital had a high birth frequency (61.2%). Furthermore, the comparative analysis of the risk of death between this unit and others showed a 7.5 higher risk of death in general hospitals and 3.2 higher in maternity units, with statistical significance (p < 0.001). Moreover, births in level II intensive care units had 3.9 times more risk of death compared with level III (p < 0.001). CONCLUSION This study foments the discussion of two possible strategies in the treatment of gastroschisis in newborns. First, the centralization of care in tertiary units, enabling malformation care to be analyzed in a more detailed and standardized manner. Second, and perhaps more feasible, the elaboration of clinical guidelines to standardize immediate care for gastroschisis in babies born outside tertiary centers, as well as the standardization of their transportation until arrival at the tertiary center.

RESUMO OBJETIVO Analisar a mortalidade e fatores associados em uma série de nascimentos com gastrosquise no estado do Rio de Janeiro em 10 anos (2005 a 2014). MÉTODO Estudo de coorte retrospectiva, no qual foram relacionadas as bases de dados do Sistema de Informação sobre Nascidos Vivos e do Sistema de Informação sobre Mortalidade por linkage probabilístico. A base de dados final foi construída em duas etapas, que consistiram em: preparo das duas bases de dados iniciais e estabelecimento de relações entre elas. RESULTADOS Os recém-nascidos pré-termo e os com baixo peso ao nascer tiveram maior chance de óbito, com significância estatística (p = 0,03 e p = 0,006, respectivamente). Em relação ao local de nascimento, embora a frequência de óbito tenha sido maior nas maternidades do que em hospitais gerais (p = 0,04; OR = 0,5; IC95% 0,3-1,0), foi observado que uma unidade caracterizada como hospital geral apresentou uma frequência alta de nascimentos (61,2%) e, na análise comparativa da chance de óbito dessa unidade com as demais, encontrou-se uma chance de morrer 7,5 maior em hospitais gerais e 3,2 maior em maternidades, com significância estatística (p < 0,001). Além disso, nascer em unidades de terapia intensiva tipo II aumentou a chance de óbito em 3,9 vezes em comparação com as do tipo III (p < 0,001). CONCLUSÃO Este estudo dá subsídios para a discussão de duas possíveis estratégias no tratamento de recém-nascidos com gastrosquise. A primeira seria a centralização do cuidado em unidades terciárias, possibilitando que o cuidado à malformação seja analisado de forma mais minuciosa e padronizada. A segunda, e talvez mais factível, seria a elaboração de diretrizes clínicas que padronizem o cuidado imediato aos bebês com gastrosquise nascidos fora de centros terciários, bem como a padronização do transporte deles até a chegada ao centro terciário.

Implicações da multimorbidade na utilização de serviços hospitalares por idosos internados

RESUMO Objetivo: Analisar as implicações da multimorbidade na utilização de serviços hospitalares por idosos internados em um hospital ensino no Sul do Brasil, considerando características sociodemográficas e de estilo de vida. Material e método: Estudo quantitativo, transversal, descritivo, com utilização de dados obtidos por meio de entrevista telefônica junto à pacientes 144 idosos internados, em um hospital universitário do estado do Paraná. Os dados foram analisados pelo teste qui-quadrado. Verificou-se que 55% dos idosos apresentaram multimorbidades. Resultados: Prevaleceram mulheres, idosas brancas, com baixa escolaridade, com renda entre entre 1 e 2 salários mínimos e que residiam com outras pessoas. A presença de multimorbidade foi significativamente associada a: baixa escolaridade; serviço de internação; maior tempo de internação; maior tempo e necessidade de cuidados na unidade de terapia intensiva; maior atenção do serviço social hospitalar; ajuda do familiar / cuidador após a alta para seguir as recomendações médicas e menor retorno ao atendimento ambulatorial após a alta (p <0,05). Conclusão: A utilização de serviços hospitalares de saúde por idosos com multimorbidades foi mais representativa e durou mais tempo, em comparação com os isentos dessa condição.

ABSTRACT Objective: To analyze the implications of multimorbidity for the use of hospital services by elderly people admitted to a teaching hospital in Southern Brazil, considering sociodemographic and lifestyle characteristics. Materials and methods: A descriptive, cross-sectional quantitative study, using data obtained by telephone interview with 144 elderly patients admitted to a university hospital in the state of Paraná, Brazil. Data were analyzed using the chi-square test. It was verified that 55% of the elderly people presented multimorbidities. Results: There were more white elderly women, with low schooling level and an income between 1 and 2 minimum wages, who lived with other people. The presence of multimorbidity was significantly associated with low schooling; hospitalization service; longer hospital stay; longer duration and need for care in the intensive care unit; greater care from the hospital social service; help from the family/ caregiver after discharge to follow the medical recommendations and lower return to outpatient care after discharge (p <0.05). Conclusion: The use of hospital health services by elderly people with multiple morbidities was more representative and lasted longer, compared to those without this condition.

RESUMEN Objetivo: Analizar las implicaciones de la multimorbilidad en el uso de los servicios hospitalarios por los ancianos ingresados en un hospital universitario del sur de Brasil, considerando características sociodemográficas y de estilo de vida. Material y método: Estudio cuantitativo, transversal, descriptivo, utilizando datos obtenidos a través de entrevistas telefónicas con 144 pacientes ancianos ingresados en un hospital universitario del estado de Paraná. Los datos se analizaron mediante la prueba de chi-cuadrado. Se encontró que el 55% de los ancianos presentaba multimorbilidades. Resultados: Prevalecieron mujeres, ancianos blancos, con baja escolaridad, con ingreso entre 1 y 2 salarios mínimos y que residen con otras personas. La presencia de multimorbilidad se asoció significativamente con: baja educación; servicio de hospitalización; estancia hospitalaria más prolongada; más tiempo y necesidad de cuidados en la unidad de cuidados intensivos; mayor atención del servicio social hospitalario; ayuda de familiar/cuidador posterior al alta para seguir las recomendaciones médicas y menor retorno a la atención ambulatoria del hospital posterior al alta (p <0,05). Conclusión: El uso de los servicios de salud hospitalaria por personas mayores con multimorbilidades fue más representativo y duró más, en comparación con aquellos exentos de esta condición.

Quality indicators in type 2 diabetes patient care: analysis per care-complexity level.

BACKGROUND: This study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System's primary and tertiary health care centers within a local population. METHODS: This was a retrospective cohort of 488 patients with type 2 diabetes (148 in each primary health care unit, ESF and UBS, and 192 at the tertiary health care unit) with a 1-year follow-up to evaluate the following care quality indicators: nephropathy, neuropathy and retinopathy tests, yearly lipid profile and nutritional assessments, and an inquiry about tobacco use. The presence of > 50% of the quality of care assessment measures was considered acceptable. Indicators were also evaluated in relation to patients without proper diabetes control (HbA1c > 8.5%). RESULTS: In the results, a high percentage of patients were excluded specifically for not presenting the two HbA1c tests within a year (n = 208, 58.1% at ESF; n = 225, 58.4% at UBS; and n = 39, 16.9% at the tertiary health care unit). From the included patients, only 7 (4.7%) at ESF, 7 (4.7%) at UBS, and 52 (27.0%) at the tertiary health care unit showed > 50% of the quality criteria covered. When only patients without proper diabetes control were evaluated, none of them at any of the health care units showed all the quality criteria covered. CONCLUSIONS: Our results show a low percentage of care assessment measures at each evaluated health care unit, pointing out the need to improve the protocols and care lines of diabetic patients.

Nurse competence in the interface between primary and tertiary healthcare services.

AIMS: (a) To explore nurses' self-assessed competence and perceived need for more training in primary and tertiary healthcare services; and (b) to investigate the factors associated with these issues. DESIGN: Quantitative, cross-sectional, descriptive. METHODS: The ProffNurseSAS, the Job Satisfaction Scale and socio-demographics were used. A convenient sampling method was used to invite registered nurses from 23 primary (N = 104) and tertiary care wards (N = 26). RESULTS: Five significant differences in self-assessed competence were identified, with none regarding the perceived need for more training between nurses working in primary versus tertiary health care. Nurses in primary health care had longer experience, and a larger proportion had continuing education. Nevertheless, this was not associated with either self-assessed competence or the perceived need for more training. Years of experience, training or reported job satisfaction was not associated with the items on the ProffNurseSAS. CONCLUSION: Findings indicate that nurses' competence is same in primary and tertiary healthcare settings. Moreover, the findings of this research highlight areas that need further improvement and emphasis from both leaders and educational institutions when they attempt to ensure nurses' competence.